van Toorenburg M M, Sanches S A, Linders B, Rozendaal L, Voorendonk E M, Van Minnen A, De Jongh A
Research Department Psychotrauma Expertise Centre(PSYTREC), Bilthoven, The Netherlands.
Phrenos Center of Expertise for Severe Mental Illness, Utrecht, The Netherlands.
Eur J Psychotraumatol. 2020 Feb 24;11(1):1724417. doi: 10.1080/20008198.2020.1724417. eCollection 2020.
: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing. : To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. : Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. : PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from post-treatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not. : The results support the notion that the severity of emotion regulation difficulties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.
关于是应首先改善情绪调节问题以便从创伤聚焦治疗中获益，还是在成功进行创伤处理后情绪调节问题会减轻，目前仍存在争议。为了增强我们对成年重度创伤后应激障碍（PTSD）患者创伤聚焦治疗结果中情绪调节困难的重要性的理解，我们区分了12岁之前报告遭受性虐待的人、虐待开始时年龄为12岁或更大的人、符合PTSD分离亚型标准的个体以及不符合该标准的个体。62名重度PTSD患者接受了为期八天的强化治疗方案，该方案结合了两种针对PTSD的一线创伤聚焦治疗（即延长暴露疗法和眼动脱敏再处理疗法），且没有针对情绪调节困难的前期干预措施。在治疗前、治疗后和六个月随访时评估PTSD症状评分（CAPS - 5）和情绪调节困难（DERS）。创伤聚焦治疗后，PTSD严重程度和情绪调节困难显著降低。虽然从治疗后到六个月随访期间PTSD严重程度评分显著增加，但情绪调节困难并未增加。情绪调节困难并不能预测治疗反应和复发情况。12岁之前遭受童年性虐待的幸存者和那些在生命后期遭受性虐待的人在情绪调节困难方面改善程度相同。符合PTSD分离亚型标准的个体在治疗期间情绪调节困难的下降程度与不符合该标准的个体相似。结果支持这样一种观点，即情绪调节困难的严重程度与PTSD创伤聚焦治疗的较差结果无关，也与治疗完成后的复发无关。此外，即使是遭受过童年期性创伤的个体和患有分离亚型的个体，在创伤聚焦治疗后情绪调节困难也有所改善。
